HC Deb 01 March 1957 vol 565 cc1637-48

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wills.]

4.0 p.m.

Mr. Marcus Lipton (Brixton)

There is statistically an incontrovertible association between cigarette smoking and the incidence of lung cancer. I shall quote my authority for making that statement a little later, but I want to put some questions at once to the Parliamentary Secretary to the Ministry of Health, whom I am glad to see present. What are the Government doing to let the people know about this most disturbing fact? I am initiating the debate to get a full answer to that question. It would be foolish, of course, to deny that in raising the matter I am not confronted with formidable difficulties in the shape of wealthy and powerful influences and interlocking interests of every kind.

The Hulton Readership Survey discloses that on each day of 1955, 11,900,000 males of 16 years of age and over—that means two men out of every three of the male population—smoked an average of 15 cigarettes a day, and that 6,300,000 women, that is, two women out of every five of the female population, smoked on an average eight cigarettes a day. If I had a magic receiver to tune into the homes of the country in the morning I should hear the rumble and roar of the millions of the free-born citizens of the country clearing their throats in preparation for another day's work and another day of cigarette smoking.

A sum of £880 million a year is spent on tobacco. Out of every £1 spent in the shops, 2s. 6d. is spent on tobacco, and each adult incurs an average expenditure of 9s. 4d. a week. Four million places are licensed for the sale of tobacco. The yield from the duty on tobacco is a matter of great interest to the Chancellor of the Exchequer. It produced £668 million in the last financial year, a record figure.

When the extra duty of 3s. a lb. was placed on tobacco in the last Budget, which meant an extra 2d. on each packet of twenty cigarettes, the Imperial Tobacco Company obtained an exceptional profit of £2½ million by the sale of pre-Budget stocks at post-Budget prices. The Government received their share of the swag because out of that sum they obtained about half, which left the Imperial Tobacco Company with an extra profit of £1,888,000 after tax had been deducted. That one company controls about 70 per cent. of the production of cigarettes in this country, and its gross profit last year was £27 million.

I mention these facts to give the background to the problem, and to show that anybody who tries to do something about it is faced with one or two rather difficult hurdles. On 12th February, 1954, the then Minister of Health, speaking of a Committee which had been studying the connection between cigarette smoking and lung cancer, said: I accept the Committee's view that the statistical evidence points to smoking as a factor in lung cancer…"—[OFFICIAL REPORT, 12th February, 1954; Vol. 523. c. 174.] The Minister went on to say that there was no further evidence which enabled him to come to an immediate decision in the matter and that he was looking forward to further research and the results that might accrue from them.

At the same time the Minister informed us that the tobacco companies had offered to give £250,000 for research in this respect. On 18th February the Parliamentary Secretary to the Ministry of Works informed the House that the statistical investigation which had been carried out at a cost of £7,000 had not been hampered by lack of funds.

Two years roll on, and then we find the Minister of Health telling the House, in February, 1956: …I must first of all, when considering publicity, obtain the advice of the Central Health Services Council, which at the moment is not satisfied that more publicity should be given to this problem."—[OFFICIAL REPORT, 27th February, 1956; Vol. 549. c. 831.] We then move on to March, 1956, when, again questioned in the House on the subject of a publicity campaign, the Minister of Health said: My Standing Medical Advisory Committee and the Central Health Services Council have again considered this. I am advised that appropriate action should be taken to inform the public about what is known of the connection between smoking and cancer of the lung. I shall now consider what action would be appropriate."—[OFFICIAL REPORT. 19th March. 1956; Vol. 550. c. 86.] A week later the Minister told the House: …I have this very important subject under urgent review."—[OFFICIAL REPORT, 26th March, 1956; Vol. 550, c. 1766.] On 16th April, 1956, he begins to shift his ground apparently, and says: I have to see exactly what developments have taken place since two years ago."—[OFFICIAL REPORT, 16th April, 1956; Vol. 551, c. 673.] The Minister was referring, presumably, to the statement made in the House in February, 1954.

On 7th May, 1956, there were several Questions down on the subject to the Minister and, be it noted, all statements on the subject by the Government have only been squeezed out of them as a result of Questions in this House. The Minister said: The number of deaths from cancer of the lung has risen from 2,286 in 1931 to 17,271 last year…The chairman of a committee of the Medical Research Council which has been investigating the subject con-skiers that the fact that a causal agent has not yet been recognised should not be allowed to obscure the fact that there is, statistically, an incontrovertible association between cigarette smoking and the incidence of lung cancer. The statistical evidence from this and other countries to which he refers tends to show that mortality from cancer of the lung is twenty times greater amongst heavy smokers than amongst non-smokers. The Government will take such steps as are necessary to ensure that the public are kept informed of all the relevant information as and when it becomes available."—[OFFICIAL REPORT, 7th May, 1956; Vol. 552. c. 803.] So the old gramophone record was on once again.

Then we come to the report of the investigation that had been carried out by Professor Bradford-Hill and Dr. Doll, which again was made the subject of Questions to the Minister in the House in November last. When questioned about it, the Minister said: A recent paper by Professor Bradford Hill and Dr. Doll confirms the statistical association between smoking and lung cancer, about which I made a statement in the House on 7th May. I will ensure that the public are kept informed of all relevant information as and when it becomes available …. The Minister went on to say that he did not consider a publicity campaign of any kind was desirable at the moment. He said, in response to a Question which I put to him: This is a very important paper by Dr. Doll and Professor Bradford Hill, and I am anxious to see that it gets full publicity; but it only confirms the facts previously known and mentioned on 7th May."—[OFFICIAL REPORT, 19th November, 1956; Vol. 560, cc. 1356–7.] On 28th January this year I asked the Minister: to appoint a Select Committee to consider what immediate and practical steps can be taken to reduce cigarette smoking. The Minister turned down that suggestion, and at the same time said: I do intend to look further into this matter and to take the advice of those eoncerned."—[OFFICIAL, REPORT, 28th January, 1957; Vol. 563, c. 656–7.] There it is. The Government are very actively concerned in doing nothing at all.

The Chancellor of the Exchequer, speaking at Barnstaple on 18th January last, said: We at the Treasury do not want too many people to stop smoking. In the light of the evidence that has already been made available, that was probably the most disgusting and immoral thing that any Minister of the Crown has ever said. Let it be mentioned to the credit of the Daily Express that it was apparently the only national daily paper which did not "blue pencil" that part of the Chancellor's speech. In his speech the Chancellor commented on the advantages of the "Opportunity State". I have come to the conclusion that the "Opportunity State" of which the Chancellor then spoke is a State in which as many people as possible have the opportunity of incurring the disease of lung cancer.

I took the matter up with the Prime Minister in the House on 7th February. The Prime Minister gave what has come to be a typically flippant, stupid and arrogant reply: I have yet to meet a man whose sense of public duty is so highly developed that he is deterred from giving up smoking by a fear that that might mean a loss to the revenue."—[OFFICIAL REPORT, 7th February, 1957; Vol. 564, c. 611–2.] The right hon. Gentleman got a cheap laugh, but that was all.

A few days later my hon. Friend the Member for Barking (Mr. Hastings) was told by the Minister of Health, in a Written Answer: At their meetings in December last these bodies"— the Standing Medical Advisory Committee and the Central Health Services Council— repeated the advice already given to my predecessor. Like him, I propose to ensure that the public are kept informed of all relevant information as and when it becomes available."—[OFFICIAL. REPORT, 25th February, 1957; Vol. 565, c. 127.] I am sorry that I have had to indulge in so much tedious repetition but it has been forced upon me by the tediousness and the repetitiveness of the replies that we have obtained from successive Ministers of Health.

I wish to quote two doctors in support of my argument. The first is Dr. Horace Joules, M. D. Lond., F.R.C.P., Physician and Medical Director at the Central Middlesex Hospital, who is a member of the Standing Medical Advisory Committee and the Central Health Services Council. In a lecture to the Middlesex County Medical Society, printed in the Lancet on 8th December, 1956, he said: Cancer of the lung continues to cause more and more deaths. It is in the approach to this grave national problem that the Ministry of Health has manifested its weakest aspect. The upward trend of mortality shows no sign of abating. We are witnessing an epidemic form of cancer which has been unknown in human society before. Scientific study leaves no doubt of the causal relationship between 80 per cent. of these cases and cigarette consumption. Unless trends are modified, a million people in England and Wales will die of this cancer before the end of the century…So far the Minister of Health has refused to accept the advice of the Standing Medical Advisory Committee which has counselled continuous education of the public about the risks of cigarette smoking. If, as seems probable, the Minister is acting upon a Cabinet decision, the situation is even more serious. It means, I believe, that the health of our people is being sacrificed to the collection of £650 million annually from the tax on tobacco. That is my first witness.

My second witness is Dr. J. G. Scadding, M.D., F.R.C.P., Director of Studies and Dean of the Institute of Diseases of the Chest, and also the member of the Standing Medical Advisory Committee, who, in a letter to me on 25th February, 1957, which I have his permission to quote, wrote: In view of this accumulated evidence of the ill-effects of smoking, not only in respect of lung cancer but also in aggregating other important diseases of the respiratory system, it is of course deplorable to know that the consumption of tobacco in this country continues to increase, and that the only response of the last Minister of Health to the repeated advice of his Standing Medical Advisory Committee that specific steps should be taken to make the facts known in an effective way was to make a statement in the House of Commons, of which the most significant part was the expression of his view that in the present state of knowledge a national publicity campaign would not be appropriate. The steady accumulation of evidence of the ill-effects of smoking on the public health makes it more than ever imperative that the new Minister of Health should abandon the Fabian tactics of his predecessor, and make known to the public, in an arresting way, the risk of premature death which the smoking habit entails. Nothing short of an intelligently designed campaign can hope to counteract the insidious propaganda in favour of smoking to which the public is at present constantly exposed. That propaganda entails the expediture of £2 million on Press advertising and £¼million has been spent on television advertising. That is the measure of the problem with which we are faced.

It would be a grave dereliction of responsibility on the part of the Minister and the present Government if they deliberately continued to blind themselves to the seriousness of the situation and refused to take further action immediately. I hope that in the reply which will be forthcoming the Government will not shelter behind a stale and outworn formula but will do the job for which the Ministry of Health is appointed and paid, namely, to protect and improve the health of the people. There can be no more sacred task to be performed than the task and duty imposed on the Ministry in this respect.

4.17 p.m.

Mr. Richard Fort (Clitheroe)

The hon. Member for Brixton (Mr. Lipton) seemed more concerned with scoring cheap points off the tobacco companies and the Government than with considering one of the more complicated medical problems of our time.

The statistics the hon. Member put before the House are the certain facts in the problem of lung cancer. The point he failed to emphasise at all is that the kind of work to find out the reasons for the statistical facts is very complicated and difficult scientific work, as professional hon. Members, including the right hon. Lady the Member for Warrington (Dr. Summerskill), opposite know. This difficult research has to be done in order to investigate fully what the reason is for the really tragic increasing rate of lung cancer. From what the hon. Member said, one would have thought that in fact nothing was being investigated, but constantly increasing sums of money are being spent—now a total of over £68,000. That amount would be more, but owing to the difficulty of the work it takes time to collect and train adequate staff to carry it out.

The Medical Research Council, of which I have the honour to be one of the lay members, has now established three groups which are working on this problem, the one at Exeter having been provided with a new temporary laboratory to investigate the chemistry of tobacco smoke. The three points on which much more work is needed are: a fuller statistical analysis—as I think Professor Bradford Hill and his co-workers think is necessary—much more work on the effect on animals of the products from burning tobacco and, thirdly, the complex problems connected with smoking, air pollution, chronic bronchitis and lung cancer. In a field as complicated as this, to make a speech such as the hon. Member made is merely to raise a smokescreen rather than to throw clarity on this difficult problem.

4.20 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. J. K. Vaughan-Morgan)

Mr. Speaker, this is positively my last appearance at the Box today.

The hon. Member for Brixton (Mr. Lipton) referred in some rather graphic phrases to an old gramophone record and to tedious repetition. Fortunately, in his reference to tedious repetition he has shown quite clearly what I want to say—that the Government have not hesitated to announce to the public any discovery as and when it became available. I think it would be more reasonable if I dissipated some of what my hon. Friend the Member for Clitheroe (Mr. Fort) rather aptly called the smokescreen which the hon. Member for Brixton put up, and it might be for the convenience of the House if I summarised what I might call the present state of discovery in this country.

Mr. Lipton

What is the Minister doing about it?

Mr. Vaughan-Morgan

If the hon. Member will only stay and listen he will hear what is happening. He did not do justice—I do not know whether it was his intention to do justice—to what is the position in this very difficult and delicate matter. The whole House and the whole of the public will agree that we must give full publicity to the knowledge which is available but must not indulge in any form of sensationalism.

There has been very little advance since the statement which my right hon. Friend the Member for Thirsk and Malton (Mr. Turton) made on 7th May, 1956. The carefully-controlled inquiries have shown statistically that smokers have a significantly higher mortality rate from lung cancer than have non-smokers. The figure increases in direct proportion to the amount smoked, until among lifelong heavy smokers, who may be defined as those smoking about 25 cigarettes a day, it appears that about one in ten can be expected to die of lung cancer before the age of 75.

Among heavy and continuous smokers of cigarettes—that is, those smoking substantially more than 25 a day—the death rate from lung cancer is about forty times that among non-smokers. The rates among pipe smokers for the same amount of tobacco smoked are less than among cigarette smokers. Former smokers—a class to which I belong—who have given up smoking have significantly lower rates than those who have continued to smoke.

As the House will appreciate, there are many ways of interpreting the statistical evidence available and it is difficult to reduce the evidence to average figures, but without doubt the findings which I have just summarised constitute prima facie statistical evidence that smoking carries a risk of lung cancer in human beings.

Again—and the hon. Member did not deal with this side of the problem at all—we must view this mortality rate and these risks with a due sense of proportion. It is better to let the figures speak for themselves than to indulge in any sensational conjecture. For example, out of a total of 518,000 deaths in England and Wales in 1955, 17,000 were due to lung cancer out of a total of 91,000 for all forms of cancer. That 17,000 compared with 28,000 for bronchitis and 70,000 for coronary disease and angina, apart from other forms of heart disease. In other words, we must try to get this in perspective and to realise that lung cancer is not our only problem, nor must it be our only preoccupation nor should we give it any more priority than the figures justify. Nevertheless, it is undoubtedly the case that the lung cancer figures continue to show a steady increase, which has varied from 5.7 to 8.2 per cent. per annum over the last five years.

Let me turn to what has been done in research since 1950. Two reports have been published, the most recent in November last, and further information will be available and will be published as time goes on. The Medical Research Council is at present engaged in an extensive programme for the purpose of throwing more light upon the exact nature of the relationship between smoking and lung cancer, the long-term aim being to identify those constituents of tobacco smoke which may be active in producing cancer. There has, as my hon. Friend said, recently been built a new laboratory at Exeter devoted to fundamental work on the chemical analysis of tobacco which, incidentally, is the first fruits of the grant of £¼ million from the tobacco companies of this country which the hon. Gentleman abused so forcefully.

This is not all. Research is continuing on wider aspects than those which I have just mentioned. It can fairly be said that there is at present no promising line of research which is being neglected for lack of funds. The Government are spending £364,000 a year on cancer research of all kinds through the Medical Research Council alone. But as well as that, research is going on in hospitals and universities all over the country. Voluntary organisations are making very large contributions. If the hon. Member for Brixton is interested, I hope he will refresh his memory about the debate of 19th May, 1953, when full details were given of the scope of the research taking place at that time.

Dr. Barnett Stross (Stoke-on-Trent, Central)

Have the Minister and his right hon. Friend approached the Minister of Education to see that children should be taught about this matter?

Mr. Vaughan-Morgan

I am coming to that point in a second.

The Medical Research Council is currently reviewing the existing evidence, and its considered views should be available before very long. The Government will give those views their full and urgent consideration when they are forthcoming, and I reiterate the pledge given before and repeated by my right hon. Friend that the public will be informed of all the evidence as it becomes available. It is for that reason that I have tried to summarise the evidence before the public at the present time.

In connection with what the hon. Member has said, I should like to draw the attention of the House to Pamphlet No. 31 on Health Education issued by the Ministry of Education which, I hope, will get into the hands of all those concerned with the health and education of children and young people. It gives some considered and helpful advice on the subject, and I recommend it to the hon. Member opposite for study.

The hon. Member dealt with the matter in what. I think, was rather a sensational manner, and I have endeavoured to counteract that. It is the firm intention of Her Majesty's Government to reveal the truth as it comes to light, but we must avoid, as I am sure would be the desire of the House, any unnecessary sensationalism on this very difficult subject.

Dr. Edith Sununerskill (Warrington)

May I ask the Minister why he has ignored completely the evidence presented by my hon. Friend and contained in letters which he has received from doctors, particularly the one from the doctor at Brompton Hospital, which is about the most famous chest hospital in the world?

Mr. Vaughan-Morgan

I am certainly delighted to reply to the right hon. Lady. The important organ in this matter is, I think, the Medical Research Council, which will no doubt take cognisance of the views of those two doctors. But until its evidence is complete, I think we ought to avoid any hasty conclusion.

Dr. Summerskill

If it is necessary to warn schoolboys of the dangers of smoking, why is it not equally necessary to warn older people?

Mr. Vaughan-Morgan

The answer is that we are making statistical evidence available to the public by this debate today, and I think it better for the public to judge for themselves from the facts and figures given.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Four o'clock.